Abstract
Drawing on our clinical experience with Syrian refugees in Lebanon, we reflect on the difficulties encountered to delineate the limits between psychiatric care and social assistance within a dysfunctional humanitarian system. We note that many refugees consider mental health services a gateway to legitimize their vulnerability status to aid agencies. They may therefore resort to changing narratives as an adaptive mechanism facing institutional ambiguity, in the hope of getting financial support or resettlement to a third country. This may put clinicians in a difficult dual role, acting simultaneously as the treating and the forensic physician. We describe two clusters of ‘internalized’ and ‘externalized’ behaviors that may be reinforced by the assistance system. These may indicate an underlying structural dysfunction and a lack of trust on the part of refugees in the capacities of the humanitarian system to help them. At the clinical level, we suggest implications to strengthen the therapeutic alliance and avoid mistrust.